How Obamacare Accomplishes The Unthinkable

The enrollment figures and poll numbers show reform has backfired

By Ben Domenech

President Obama’s signature domestic policy may have accomplished something previously unthinkable: taking an issue where one party had a dominant hold on public opinion, and reversing it in favor of the opposing party.

If the latest poll numbers and enrollment figures are to be believed, we could be witnessing a political achievement unequaled in modern political history: the complete demolition of one party’s long-term dominance on an issue area – the Democrats’ ownership of the health care issue – in the space of a few months. Quinnipiac finds that young people trust Republicans in Congress more on health policy than the president; that a plurality of Hispanics, long the most pro-Obamacare faction, are now opposed to the law; and that overwhelming majorities (70+ percent) of Democrats, Republicans, and Independents are in favor of delaying the law. And that’s not all:

Only 19 percent of American voters say the quality of care they and their families receive will improve in the next year because of the Affordable Care Act (ACA), while 43 percent say it will get worse and 33 percent say ACA won't affect their health care. Voters oppose the ACA 55 - 39 percent, with men opposed 59 - 37 percent and women opposed 51 - 41 percent. American voters are divided 46 - 47 percent on whether Obama "knowingly deceived" the public when he said people could keep their existing health insurance plans if they wished. Voters also support 73 - 20 percent extending the March 31, 2014 deadline for signing up for coverage without facing a penalty.

No wonder we’re seeing these kinds of numbers, when even die-hard supporters of the law are getting hit hard by its ramifications. And for what? The enrollment figures released today illustrate that the administration has failed thoroughly in managing Obamacare’s launch, with just 26,794 people having enrolled via Healthcare.gov (and even that definition is dubious, given that the federal site reportedly is unable to process payments at this time). Comparison to the four million or so people who have lost their existing plans is laughable.

 All told, the federal exchange enrollment figures work out to just 23 people per day per state signing up via the site. The whole project now looks like the creation of a tiny high risk pool and a Medicaid expansion in half the states. 

As the American Action Forum outlines in this chart, the project is so far behind the expected and hoped-for pace, it seems unthinkable that it would ever approach estimates in the near future:

All this has led Ezra Klein to publicly voice the concerns that smart progressives have been whispering about for weeks now:

The Affordable Care Act's political position has deteriorated dramatically over the last week. President Bill Clinton's statement that the law should be reopened to ensure everyone who likes their health plans can keep them was a signal event. It gives congressional Democrats cover to begin breaking with the Obama administration. 

The most serious manifestation of that break is Sen. Mary Landrieu's "Keeping the Affordable Care Act Promise Act." It's co-sponsored not just by the usual moderate Democrats -- Landrieu and Dianne Feinstein and Mark Pryor and Kay Hagan -- but also by Oregon liberal Jeff Merkley. It's worth noting that Merkley is up for reelection in 2014.

The argument Landrieu is making on behalf of the bill will appeal to many Senate Democrats. "When we passed the Affordable Care Act, we did so with the intention that if you liked your health plan, you could keep it," she said on the Senate floor. "A promise was made and this legislation will ensure that this promise is kept." It's an underplayed dynamic of the current political storm that many congressional Democrats feel Obama broke a promise he made to them, as well.

The bill Landrieu is offering could really harm the law. It would mean millions of people who would've left the individual insurance market and gone to the exchanges will stay right where they are. Assuming those people skew younger, healthier, and richer -- and they do -- Obamacare's premiums will rise. Meanwhile, many people who could've gotten better insurance on the exchanges will stay in bad plans that will leave them bankrupt when they get sick... Put simply, the Landrieu bill solves one of Obamacare's political problems at the cost of worsening its most serious policy problem: Adverse selection.

The reason for Bill Clinton’s remarks yesterday are obvious: he understands the political implications, for the party and for Hillary, if Obamacare fails, and this is a savvy bit of CYA in preparation for 2016. The problem is that what he’s proposing, and what Landrieu is trying to require, is very difficult to achieve (if not entirely impossible) given the requirements involved and the closing window on grandfathering or anything of the kind. Achieving that type of fix would require a broad bipartisan agreement in short order, one that seems impossible in today’s Washington. We’re going to continue to see stories like this: a million more Californians lose insurance, state officials try to exert pressure… and Feinstein flip-flops.

 

But all this is to no avail. Just because there’s massive political pressure for Senate Democrats to do something doesn’t mean the White House agrees with those Senate Democrats. If anything, they’re doubling down on the idea that nothing can be doneand that the Senate just has to accept it:

After the president’s apology last week for wrongly assuring Americans that they could retain their health plans if they wanted, senior White House aides said the president wanted to ensure that people who were forced off older policies with less comprehensive coverage were not stuck with higher monthly premiums to replace their insurance. But administration officials declined to say how they might achieve that goal, how much it would cost or whether it would require congressional approval. At the same time, officials signaled the president’s strong opposition to calls from across the political spectrum — including one Tuesday from a key ally, former President Bill Clinton — to support bipartisan legislation that would allow people to keep their current insurance plans even after provisions of the Affordable Care Act go into effect next year. White House officials refused to discuss in detail what options Mr. Obama was considering. But they made clear that the president was skeptical of any solution that would allow insurance companies to continue selling what officials consider to be cheap and substandard policies.

Megan McArdle and Peter Suderman have more on the worst case scenarios. It never seemed like we would get to this point – after all, the whole effort behind Obamacare included multiple aspects designed to insulate insurers. But we may be about to see the death by a thousand cuts. As Bob Laszewski writes today:

The audacity of this administration to continue telling people to keep going back to the website and the call center when they knew full well that only 25 people per day per state were making it thorough the gauntlet that is Healthcare.gov is startling. This program is in grave danger of collapsing if the administration cannot dramatically grow the size of the risk pool and attract healthy people to it.

Had the administration admitted its management failure before the exchanges launched, or traded a delay of implementation in the course of negotiation, it could’ve taken a political hit, but avoided the policy failure. Perhaps it’s the curse of second-term hubris: Obama has no intention of dismantling the one significant domestic policy he’s pushed through for the sake of a few Democratic red state Senators. He thinks what he’s achieved with the law is too important to sacrifice – and in the end, that may make the law even more vulnerable.